Preparing for Implementation of the ACA in New Jersey

Supporting activities to address legislative, regulatory, and logistical questions

    • May 28, 2014

Dates of Project: April 15, 2012 to May 31, 2013

Problem Synopsis: Like other states, New Jersey faced a host of legal, regulatory, and logistical issues as it prepared to implement the requirements of the Affordable Care Act (ACA). Among these were the law’s requirements that most individual and small group insurance plans must cover a series of Ten Essential Health Benefits and the possibility of providing a state-designed Basic Health Program for coverage of low-income individuals not eligible for Medicaid.

Description: The Center for State Health Policy commissioned two reports, one by the Seton Hall School of Law on the legal and regulatory implications of the Ten Essential Health Benefits requirements, and one by Oliver Wyman Actuarial Consulting on the financial implications of a Basic Health Program. Center staff completed their own report on the adequacy of health care resources in the state to satisfy the ACA’s demands.

Key Findings

  • Included in the reports are the following findings.

    • A Basic Health Program could provide a higher level of benefits at a lower cost to eligible low-income individuals, but it would pose some significant financial and other risks to the state.
    • The state must adopt a model plan covering the Ten Essential Benefits. Monitoring and enforcement will be necessary to ensure that health plans offer and pay for these benefits.
    • Few New Jerseyans reported having trouble finding a physician, and most of them found one eventually. Finding a doctor who would accept their insurance proved more challenging.